DOI: https://doi.org/10.36347/sjmcr.2026.v14i05.089

Pages: 1235-1238

Congenital anomalies of the internal carotid artery (ICA) are exceptionally rare vascular developmental abnormalities. Although frequently asymptomatic because of collateral cerebral circulation, these anomalies may be revealed by ischemic or hemorrhagic cerebrovascular events. We report the case of a 66‑year‑old hypertensive patient presenting with language disturbances and right‑sided paresthesias. Brain CT and MRI demonstrated a subacute ischemic lesion involving the left thalamus associated with bilateral ICA anomalies characterized by agenesis of the right ICA and severe hypoplasia of the left ICA. Multimodal imaging, including MR angiography and CT angiography, confirmed the congenital nature of the anomalies and demonstrated collateral supply through enlarged posterior communicating arteries. This observation highlights the importance of recognizing congenital ICA dysgenesis and the major role of imaging in diagnosis, characterization of collateral pathways, and detection of associated vascular complications.